Are you
- feeling disturbed by having witnessed things at work that are morally wrong?
- plagued by thoughts of whether or not you did the right thing?
- feel betrayed by colleagues or managers you once trusted?
- struggling with strong feelings of guilt, shame, disgust and/or anger?
If you answered yes to any of these questions you might be experiencing something call “moral injury”. And you’re not alone. A recent study by the BMA found that half of the doctors they surveyed resonated with these experiences.
What is Moral Injury?
Moral distress and injury are closely linked to trauma. In extreme situations people may witness things, or act in ways, that go against their moral compass. For health professionals this might mean having to make terrible decisions about when to give or withhold treatment; having to enforce policies that keep families from visiting dying loved ones; or not being able to save a patient’s life.
Sometimes we can be prevented from doing what we feel is right due to circumstances outside of our control. Even though we might be able to understand rationally why this happened, it can create a deep moral or spiritual wound. This can shake our beliefs about ourselves as being good people, and invoke feelings of shame and guilt.
Moral distress can also be caused when we feel betrayed by those in positions of authority who we previously trusted. This can happen if, for example, you feel you were put in unnecessary danger by your workplace, or you are required to enact policies that you think are wrong. These experiences can make us feel angry, helpless and ashamed. We may also feel complicit in causing harm or failing to prevent it.
The experience of moral pain (i.e. guilt or anger when we do or witness something we believe to be wrong) is not problematic in itself. In fact, these feelings can be really important in helping us to act in line with our values. It is when we try to manage or avoid this moral pain in unhelpful ways that moral injury can occur.
If we find it hard to forgive ourselves for what we perceive as moral failings, we can end up behaving in ways that are very punishing or self-sabotaging. We may develop the belief that we don’t deserve happiness or acceptance. We might start isolating ourselves, relying on substances or sabotaging our close relationships.
How to support ourselves when experiencing moral injury
Coping with moral injury can be really hard, especially when many of the contributing factors are outside of our control. We need to find ways to approach our pain, make room for it and learn from it without being pulled into self-sabotaging behaviours. Here are 7 ways of coping with moral injury that can help to strike this balance.
7 ways to respond to moral injury
1. Hear your pain – feeling guilt, shame and anger when you believe something wrong has happened tells you that you care, and that doing the right thing is important to you. It hurts because it goes against your values. If you didn’t have such a strong moral compass, it wouldn’t be so difficult to bear.
2. Notice your posture – do you find yourself avoiding eye contact, slumping, drooping or hanging your head? This can create a reinforcing feedback loop between your mind and body, increasing a sense of shame. Try to adopt a more open posture, and warm facial expression – this can often have a positive impact on our emotions, and help us get in touch with a sense of compassion for ourselves.
3. Talk – share your thoughts and feelings with others, especially those who have had similar experiences. This will help to validate and normalise your experiences, and is a great antidote to shame.
4. Grounding – this is really helpful when you feel overwhelmed by any strong emotion. Try focusing on your senses – notice 5 things you can see around you, 4 things you can touch, 3 things you can hear, 2 things you can smell and 1 thing you can taste. You can read more about grounding here.
5. Mindful acceptance – mindfulness is a powerful tool for developing greater acceptance of difficult thoughts and feelings. When we are able to accept our internal experiences as they are we are much less likely to resort to unhelpful coping strategies. This is not the same thing as accepting the situation – in fact being able to accept our thoughts and feelings can often empower us to keep fighting for the change we want to see in the world. Try this Leaves on a Stream exercise as an example of noticing and accepting our thoughts.
6. Self-compassion – learning to be compassionate towards yourself and your experiences can help to heal shame and enable self-forgiveness. Try these exercises.
7. Take valued action – re-connect to your values and take action that is in line with these. This might take the form of activism, or more internal action in terms of how you relate to yourself and others. For example, if equality is important to you how can you act to promote this at work? If compassion is important to you, what can you do to show compassion to yourself and those around you? What do you want to stand for in the face of your experiences?
If you’d like more support with this issue book in a free 20-minute call and we can think together about how I might be able to help.
